Biopsies from the combined grafting technique show tissue morphology as well as keratin and collagen expression identical to that of free gingival graft strips.1

Dr. Giulia Cerino | Switzerland

The strip gingival autograft technique was introduced by Han et al.2 to alleviate the need for extensive harvesting. This technique utilizes thin strips of free gingival autografts placed parallel to one another and fixed to the most apical extension of the prepared periosteal bed, leaving the exposed periosteum between the graft strips to heal by secondary intention. However, this surgically approach is technically demanding, time consuming, and may still cause discomfort for patients.

The combination graft technique

A recent clinical study combining strips of gingival autografts with Geistlich Mucograft® investigated the effect of this surgical intervention for correcting large mucogingival defects resulting from advanced regenerative procedures, while limiting autograft harvesting and patient morbidity. The results demonstrated a significant gain in keratinized gingiva, the approach was well accepted by the patients, and the clinically regenerated tissue appeared to be keratinized.3 Now Urban and colleagues have gone further and have histologically evaluated the soft tissue generated by the combined grafting technique.1

Geistlich Mucograft® works as a "healing repository" for keratinized gingiva1

The treatment-site samples were indistinguishable from the reference samples (free gingival graft strips). Histological staining, as well as immunofluorescence examination between 6 months and 1.5 years postoperative, revealed that keratins were appropriately expressed in the treated biopsy samples, indicating a normal differentiation pattern of oral keratinocytes.

Geistlich Mucograft® worked as a "healing repository", collecting tissue cells from the neighboring soft tissue. The strip graft on the apical end of the surgically created bed acted as a cell source and a mechanical barrier for the apical tissues of the alveolar mucosa, which are not capable of keratinizing. In this manner, the tissues from the lateral borders and from the strip graft migrated and differentiated into keratinized mucosa within the Geistlich Mucograft®.

Combined grafting technique. Cells from lateral borders /strip(blue) migrate and differentiate into keratinized mucosa within the matrix. Cells from apical tissues of the alveolar mucosa(orange) are stopped by the barrier function of the strip.1

The authors conclude: "For a large area of soft tissue augmentation, a combined strip autograft plus Geistlich Mucograft® grafting technique provides not only desired, but also physiologically normal keratinized gingiva outcomes, while reducing the harvest requirements and patient morbidity."1